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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2017, Number 4

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Acta Ortop Mex 2017; 31 (4)

Undetected traumatic posterior glenohumeral dislocation

Rosas-Medina JA

Language: Spanish
References: 17
Page: 196-201
PDF size: 258.06 Kb.


ABSTRACT

Introduction: Glenohumeral dislocation (GHD) is frequent, but traumatic posterior glenohumeral dislocation (TPGHD) is rare, with an incidence of 1-4% of all GHD. The diagnosis is a challenge: sometimes, it can be omitted due to incorrect diagnosis, absence of consideration in the differential diagnosis, suboptimal radiographic evaluation and an absence of characteristic signs and symptoms; missed diagnosis reaches 60-79% and the diagnosis can delay from 24 hours to a year. Objective: To transmit previous experiences to provide support for better diagnosing TPGHD, favoring appropriate attention. Case reports: Case 1. 34-year-old male. Delayed diagnosis of left TPGHD in the 4th week. Reverse Hill-Sachs ‹ 25%. Closed reduction, immobilization for four weeks. Follow-up at week 20, good functional recovery (UCLA = 32). Case 2. 32-year-old male. Eight months with undiagnosed left TPGHD. Reverse Hill-Sachs 25%. Open reduction, immobilization for four weeks. Eight-month post-surgical follow-up. Good functional recovery (UCLA = 29). Discussion: The diagnosis of TPGHD is difficult because of its lack of frequency. Even with delayed diagnosis-treatment, evolution can be favorable provided that the reverse Hill-Sachs injury is 25% or minor. To avoid a delayed diagnosis and inadequate attention, we must always consider the injury mechanism, physical examination with the arm fixed in internal rotation, clinical suspicion in functional deficit for external rotation, flexion and abduction, radiographic studies including true AP and scapula lateral (Y view).


REFERENCES

  1. Hazmy CH, Parwathi A: The epidemiology of shoulder dislocation in a state-hospital: a review of 106 cases. Med J Malaysia. 2005; 60 Suppl C: 17-21.

  2. Yeap JS, Lee DJ, Fazir M, Borhan TA, Kareem BA: The epidemiology of shoulder dislocations in Malaysia. Med J Malaysia. 2004; 59 Suppl F: 19-23.

  3. Krivohlávek M, Lukás R, Taller S: Undiagnosed posterior dislocations of the shoulder joint. A preliminary report. Rozhl Chir. 2007; 86 (1): 41-8.

  4. Perron AD, Jones RL: Posterior shoulder dislocation: avoiding a missed diagnosis. Am J Emerg Med. 2000; 18 (2): 189-1991.

  5. Rockwood CA Jr, Matsen FA III, Wirth M, Lippit SB: The shoulder. Fourth edition, vol. 1. Philadelphia: Saunders Elsevier; 2009: 617-770.

  6. Loebenberg MI, Cuomo F: The treatment of chronic anterior and posterior dislocations of the glenohumeral joint and associated articular surface defects. Orthop Clin North Am. 2000; 31 (1): 23-34.

  7. Millet PJ, Clavert P, Hatch GF 3rd, Warner JJ: Recurrent posterior shoulder instability. J Am Acad Orthop Surg. 2006; 14 (8): 464-76.

  8. Mimura T, Mori K, Matsusue Y, Tanaka N, Nishi Y, Kobayashi M: Closed reduction for traumatic posterior dislocations of the shoulder using the “lever principle”: two case reports and a review of the literature. J Orthop Surg (Hong Kong). 2006; 14 (3): 336-9.

  9. Kowalsky MS, Levine WN: Traumatic posterior glenohumeral dislocation: classification, pathoanatomy, diagnosis, and treatment. Orthop Clin North Am. 2008; 39 (4): 519-33.

  10. Aparicio G, Calvo E, Bonilla L, Espejo L, Box R: Neglected traumatic posterior dislocation of the shoulder: controversies on indications for treatment and new CT scan findings. J Orthop Sci. 2000; 5 (1): 37-42.

  11. Duralde XA, Fogle EF: The success of closed reduction in acute locked posterior fracture-dislocations of the shoulder. J Shoulder Elbow Surg. 2006; 15 (6): 701-6.

  12. Hill NA, McLaughlin HL: Locked posterior dislocation simulating a “frozen shoulder”. J Trauma. 1963; 3: 225-34.

  13. Hawkins RJ, Koppert GJ, Johnston G: Recurrent posterior instability (subluxation) of the shoulder. J Bone Joint Surg. 1984; 66 (2): 169-74.

  14. Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, Zanetti M: Acute traumatic posterior shoulder dislocation: MR findings. Radiology. 2008; 248 (1): 185-1993.

  15. Craig EV: “Master” en cirugía ortopédica. Hombro. 2.ª ed. Madrid, España: Marbán Libros; 2009: 289-305.

  16. Cicak N: Posterior dislocation of the shoulder. J Bone Joint Surg (Br). 2004; 86-B (3): 324-32.

  17. McLaughlin HL: Posterior dislocation of the shoulder. J Bone Joint Surg. 1952; 34-A (3): 584-90.




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